The loss of love or the failure to obtain approval, acceptance, or recognition is even more difficult to cope with. Ignominious though blame might be, one learns to defend, to parry, to guard and most of all, to shift blame elsewhere. Whoever perfects these skills in this culture, without emotional conflict, survives. But to lose love, to lose affection, to be denied approval or recognition is difficult to remedy. The only way out is to walk away and not to care, which these patients, because of dependency fixations, find most difficult to do. Dependence on external narcissistic supplies makes the person both helpless and enraged when such needs are not satisfied.

The central core of patients’ conflicts was an enormous dread for rejection by loved ones and by the group they associate with. The person was happiest when he was sure that he was loved by his family and by the group. This very dependence on being loved or accepted created an anxiety, an insecurity about losing it.

“Blame” was one of the most sensitive areas in these patients. They went to great lengths, at times devious and unnecessary, to defend or justify a feeling or reaction. As a patient went through his defense, one could literally see the tide of anger rise and fall, depending on whether he felt he had acquitted himself or not. The issue could be anything trivial or crucial. Defensiveness seemed to be an unconscious characterological trait which was automatically and facilely employed at the slightest provocation, real or imagined. It was an index of over-sensitivity to or over-anticipation of a counter- aggressive move. In some instances, it usefully and effectively created guilt in the other person, making him feel like the aggressor. Blame was cleverly shifted as the accusing finger pointed at someone else.

Depressive reactions among female patients have largely to do with separation experiences. The few female patients who developed depression following promotion had psychotic illnesses. Among the male patients in this study with reactive depressions, experiences which have to do with success and failure are the most frequent precipitating event for the illness. In addition, there were many chronic anxiety reactions generated by ambivalence towards success and failure. In a few instances, there might have been a contributory traumatic experience in the background, e.g., a heart attack or death of mother.

In a young man and in a man who was past middle age and well into his fifties, depression after the experience of failure or what was interpreted as failure was easy to understand. In the younger patient, it was akin to a rude awakening, a realization of one’s limits with the initial attempt to achieve; in the older person, it was the symbolic realization of one’s declining powers and the meaninglessness of lifelong struggle. In a sense, the older patient found himself exactly where he was thirty years or so before, except that now, with age, there was limited time and hardly any desire to start all over again.

As discussed in the chapters on symptomatology and sources of conflict, both men and women had serious difficulties in expressing, regulating, and resolving aggressive feelings, thoughts, and impulses. Two questions come to mind in the attempt to understand the dynamics of this problem, which questions may actually be pointing in the same direction. Firstly, what psychological experiences contribute to the accumulation of rage reactions of such proportion as to alarm the patient and occasionally result in a drastic affective release? This question looks into the failure of these angry affects to fuse with or be neutralized by libidinal elements in the person’s ego. Secondly, what psychological experiences have obstructed an efficacious repression and sublimation of aggressive impulses?

At this point, it may be useful to go into the sexual problems of these patients, in view of the ill-disguised passive-feminine tendencies described above. As already mentioned, these tendencies were hardly regarded as threats to one’s masculine identification. The culture allows much room for their expression without sacrificing one’s masculinity. Through the eyes of an American, for example, dependency on one’s wife and mother to this extent might be suspected as potential inroads into a man’s masculine image; the American’s index of masculinity consists of a man’s ability to be on his own and to meet his responsibilities as head and provider of the household. To him, dependency is weakness and if dependency is on a maternal figure, then it is a sexual weakness.

To the group of men in this study, the genital function, in a literal sense, is the exclusive criterion for settling doubts about one’s masculinity. This is both the personal and cultural point of view. Other stipulations, such as domination by or dependence on a woman (financially, for example), are secondary in importance and do not quite receive the same valence as they do in other cultures, except of course, if they are carried out in a deliberately harsh and castrating manner.